Revenue Integrity

The 2021 Outpatient Prospective Payment System (OPPS) final rule, released December 2, moves ahead with most of the provisions of the proposed rule. This should come as a relief to hospitals required to implement most of its policies by January 1, 2021.

The 2021 Medicare Physician Fee Schedule (MPFS) final rule, released December 2, extends certain telehealth benefits but makes cuts to the Medicare conversion factor (CF) to offset evaluation and management (E/M) changes that would otherwise have resulted in significant reimbursement increases. Most provisions of the final rule are effective January 1, 2021.

United Healthcare (UHC) recently announced that it is delaying the implementation date of its unique laboratory code policy. The policy, which was originally set to go into effect January 1, 2021, will be delayed until January 1, 2022.

CMS announced on November 25 that it is building on the flexibilities granted by the Hospitals Without Walls program to launch the Acute Hospital Care at Home program. Under this program, eligible hospitals will be allowed to treat certain inpatients in the patient’s home.

CMS recently announced coding and payment information for the administration of the COVID-19 monoclonal antibody product, bamlanivimab.

CMS will hold a webcast on Tuesday, December 8 from 2–3 p.m. Eastern to help organizations prepare to comply with the upcoming price transparency requirements.